[The new aspects of the eradication of Helicobacter pylori and the importance of bacterial resistance].
The first line treatment of Helicobacter pylori infection is a 7-day PPI-based (PPI+clarithromycin+amoxycillin or metronidazole) combined therapy. Success of first eradication attempts in the literature is around 80-90%, while in Hungary 75%. Repeated eradication is needed in 10-25% of cases. The second and third line treatments are successful only in 36% and 20% of cases. Treatment failure is increasing worldwide with the higher rates of bacterial, especially clarithromycin resistance. Patients' noncompliance, pharmacogenetic and pharmacokinetic properties of the applied drugs are important as well. The eradication success rates are unacceptable in populations with higher metronidazole and clarithromycin resistance, that is why there is a need for newer combinations. A possible solution is the application of sequential therapy, or using newer antibiotics (levofloxacin). The importance of new natural substances (lactoferrin, probiotics, plant drugs) must be further investigated.
Hagymási
Krisztina
K
Semmelweis Egyetem, Altalános Orvostudományi Kar II. Belgyógyászati Klinika, Budapest. hkriszti@bel2.sote.hu
Tulassay
Zsolt
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D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D064704:Levofloxacin; D008795:Metronidazole / Q000627:therapeutic use; D015242:Ofloxacin / Q000627:therapeutic use; D010349:Patient Compliance; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D016879:Salvage Therapy; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D064704:Levofloxacin; D015242:Ofloxacin; D017291:Clarithromycin